THU0396 SMALL INTESTINAL BACTERIA OVERGROWTH IN SPONDYLOARTHRITIS

Background: It has shown different alterations in the intestinal microbiota in patient with SpA. Tests for the detection of intestinal dysbiosis have focused on the identification of dysbiosis at the terminal ileum and colon and little has been explored in the alterations at the level of the jejunum. The tests for its detection are expensive, unavailable and invasive. The breath test is used to detect small intestine bacterial overgrowth (SIBO), being a non-invasive, simple and inexpensive test. Objectives: To determine the frequency of SIBO and the relation to the clinical activity of SpA. Methods: An analytical cross-sectional study was conducted in the period March 2018-October 2018. Patients older than 18 years, who signed informed consent, who met modified New York criteria and Caspar criteria were included. Patients were excluded who were diagnosed with active lung infection, active oral infections, interstitial lung disease, chronic obstructive pulmonary disease, acute diarrheal disease, short bowel syndrome, abdominal surgery in less than 6 months, and oral or IV antibiotics used one month before the test. Patients who fulfilled the inclusion criteria were collected demographic and clinical data, gastrointestinal manifestations were interrogated and ASDAS pcr, BASMI, BASDAI, BASFI activity scales were measured. The breath test was performed by a gastroenterologist. The concentrations of hydrogen produced by bacteria were measured by GASTROLYZER® according to the recommendations of the consensus of the American Gastroenterology Association. It was considered a positive test to change the concentrations of more than 20 ppm with respect to the basal test. To compare the frequency of SIBO, a historical cohort of patients without rheumatic diseases matched by age was taken. The data were presented in means and percentages. Student’s T and Mann-Whitney U were performed for numerical variables. Groups with chi square were compared. Results: We studied 20 patients with ankylosing spondylitis (M/F 9/11) and 11 psoriatic arthritis (M/F 1/12), mean age 54.45 ±13.52, 33 healthy controls matched by age. Positive test was found in 11 (33%) patients (8/3 EA/APs) vs 1 (3%) in controls. When comparing groups with positive test versus negative test groups, patients with SIBO consumed less SSZ (72.7 vs 90.9, p 0.008), had higher frequency of irritable bowel (54 vs 5 vs 9.1, p 0.004), antecedent of cholecystectomy (27.3 vs 9.1 p 0.01), steatorrhea (18.2 vs 0, p 0.001), and higher activity: ASDAS> 2.1 (100% vs 86.4%, p 0.199), BASMI> 4 (36.4% vs 31.8% p 0.79), BASFI> 4 (72.7% vs 50%, p 0.21), enthesitis> 1 (45.5% vs 13.6%, p 0.61). Conclusion: We found a higher frequency of SIBO in patients with SpA compared to healthy controls, but not related to disease activity. This is the first study to investigate SIBO by breath test in patients with SpA References: [1] RezaieA, Pimentel M, Rao SS. How to Test and Treat Small Intestinal Bacterial Overgrowth: Evidence-Based Approach. Curr Gastroenterol Rep. 2016;18(2):8.   [2] Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, etal.Hydrogenand Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017;112(5):775–84. [3] Machado PM, LandeweaR, Heijde Dvander, Assessment of Spondylo Arthritis international Society (ASAS). Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the nomenclature for disease activity states. Ann Rheum Dis. 2018;77(10):1539–40. [4] Levy M, Kolodziejczyk AA, Thaiss CA, Elinav E. Dysbiosis and the immune system. Nat Rev Immunol. abril de 2017;17(4):219–32. Disclosure of Interests: None declared